PGY4 woes -- it doesn't stop (board certification, maintenance of certification)

[Doctor Bagel]

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We had a session yesterday on maintenance of certification, and I left feeling hugely demoralized. One, I guess I'll have to pay $2600 next year for the privilege of taking an exam, and two, I'll have to do this self monitoring/improvement paperwork (which honestly sounds like busywork) for the rest of my life. Yay! It sounds like not being board certified is no longer a legitimate option in life, either.

I think this is the frustrating part of being a physician. You're never done, and what you've done in the past is worth nothing if you don't successfully navigate your upcoming hurdles. A medical degree is worthless without a residency. A residency will be largely worthless in the future without being board certified and so on. I think I'm engaging in some black and white thinking here, but jeez, I'm sick of this stuff.

 

[Leo Aquarius]

I'm sick of it, and I'm not even half way through residency yet.

How often do you have to get board certified? How much does it cost and is there an exam you must pass each time you apply?

 

[Doctor Bagel]

I'm sick of it, and I'm not even half way through residency yet.

How often do you have to get board certified? How much does it cost and is there an exam you must pass each time you apply?

There's an exam to initially get certified along with the 3 CSVs, which you should obtain as a resident. I think registration for the exam is $2000. I think you take a recertifying (supposedly easier) exam in 10 years, but I'm not sure. I'm ignoring thinking about the cost issues now aside from the money I need to cough up for the exam early next year. Yikes.

I think it's interesting that part of the process involves getting regular patient evaluations, even though patient evaluations haven't been shown (I think) to match with good outcomes.

 

[masterofmonkeys]

We had a session yesterday on maintenance of certification, and I left feeling hugely demoralized. One, I guess I'll have to pay $2600 next year for the privilege of taking an exam, and two, I'll have to do this self monitoring/improvement paperwork (which honestly sounds like busywork) for the rest of my life. Yay! It sounds like not being board certified is no longer a legitimate option in life, either.

I think this is the frustrating part of being a physician. You're never done, and what you've done in the past is worth nothing if you don't successfully navigate your upcoming hurdles. A medical degree is worthless without a residency. A residency will be largely worthless in the future without being board certified and so on. I think I'm engaging in some black and white thinking here, but jeez, I'm sick of this stuff.

Bureaucrats have to defend (and grow) their little fiefdoms. It's the real tyranny in the US. These guys just make up work to basically defend their existence and because they've been given monopolizing force to engender compliance, they get away with it. Over and over again.

It's why JCAHO gets more ridiculous every year. If it turned out that hospitals were actually doing a pretty good job of things (which they are), they'd have to cut back their expenses. And that could just, you know, never do. So they make up sentinel events and create ridiculous nonsense rating systems and compliance requirements.

 

[OldPsychDoc]

This is a surprise to you?

At least we're all in this together...

A couple of hints, though. I know this board has a bit of a fetish for cash private practice sometimes, but this can be one of those times where working for a large organization can be beneficial. For example, my employer reimbursed my (old style) board exam fees, and will reimburse my 10-year recertification exams as well, over and above my usual CME allowance. In addition, we already collect patient feedback and quality/performance data on all of us, so zing...it's done.

Resistance is futile.

 

[MacDonaldTriad]

As the ABPN comes to realize that one examination at the end of training probably doesn’t insure much validity in the credentialing of psychiatric talent for life, they are moving from almost completely invalid, to a little less invalid. This makes us pay money, take examinations and fill out paperwork to force us to think about our practice. This is painful and just a little above completely useless, but probably an order of magnitude more meaningful than the old way. In terms of being board certified meaning something, 10 x almost nothing isn’t very much, but it is a step towards fixing this.

We could all get out from under this if someone could figure out a quality assurance measure other than “and we insist that all of our physicians are board certified”. Until we do this, the board has a monopoly that we submit to by our own disinterest and neglect.

 

[F0nzie]

Hang in there DB! It's the final stretch. It'll get easier. CME isn't too bad. I received 6 credits for simply sitting in on an ethics training class for my part time job.

 

[Shikima]

If all they want is money, let's just cut to the chase and give them $4k/yr and call it a day without wasting our time.

 

[MacDonaldTriad]

If all they want is money, let's just cut to the chase and give them $4k/yr and call it a day without wasting our time.

When we are forced to buy window dressing, they have to make us put it on the windows.

 

[Doctor Bagel]

This is a surprise to you?

At least we're all in this together...

A couple of hints, though. I know this board has a bit of a fetish for cash private practice sometimes, but this can be one of those times where working for a large organization can be beneficial. For example, my employer reimbursed my (old style) board exam fees, and will reimburse my 10-year recertification exams as well, over and above my usual CME allowance. In addition, we already collect patient feedback and quality/performance data on all of us, so zing...it's done.

Resistance is futile.

I've got to think about what's immediately ahead of me in this training thing, so thinking ahead to the specifics of board certification prior to now wasn't something I was quite emotionally up to.

As for a big organization, that'll probably be some part of my early post-residency life because I need a stable income and benefits. From what I've seen, though, psychiatrists can't really do psychotherapy in big organizations (or very little of it), so I can see the appeal of the private practice world.

 

[Doctor Bagel]

Hang in there DB! It's the final stretch. It'll get easier. CME isn't too bad. I received 6 credits for simply sitting in on an ethics training class for my part time job.

I guess it's already easier than being on call every other weekend (done that). My long-term organizational skills are largely non-existent, so this keeping up with everything is going to be a pain.

 

[SteinUmStein]

I guess it's already easier than being on call every other weekend (done that). My long-term organizational skills are largely non-existent, so this keeping up with everything is going to be a pain.

Google Calendar... just set it and forget it, set it to automatically send you a couple of email reminders in the days or weeks before the event/date/whatever is coming up.

 

[whopper]

The biggest thing ticking me off about this process is to keep the certification the ABPN has a bunch of new requirements. OK fine, I'm cool with that. Some of those new requirements make sense and I'm sick and tired of seeing crap psychiatrists in the community. Maybe this'll lessen that.

Here's the problem. I've been to the ABPN website several times and don't even understand how to do some of those requirements and I'm a guy that has to go through law books often and read up all the fine print. Then I ask my colleagues, and remember, I'm in a department where 5 of our faculty are in the top 100 physicians list, and several of them don't even know what all of them mean! This is ridiculous.

One of my colleagues that at least thinks he knows what it means told me you really can't do it on your own. You pretty much need to pay someone like the APA hundreds of dollars to give you some type of package to help you do it.

This blows.

(And how do I get in on this scheme and become one of those evil people that can make the doctors just pay money to hope it'll go away while all I have to do is sign some paper and I get $1000 per foolish doctor!?!?!-----Just kidding)

 

[Doctor Bagel]

The biggest thing ticking me off about this process is to keep the certification the ABPN has a bunch of new requirements. OK fine, I'm cool with that. Some of those new requirements make sense and I'm sick and tired of seeing crap psychiatrists in the community. Maybe this'll lessen that.

Here's the problem. I've been to the ABPN website several times and don't even understand how to do some of those requirements and I'm a guy that has to go through law books often and read up all the fine print. Then I ask my colleagues, and remember, I'm in a department where 5 of our faculty are in the top 100 physicians list, and several of them don't even know what all of them mean! This is ridiculous.

One of my colleagues that at least thinks he knows what it means told me you really can't do it on your own. You pretty much need to pay someone like the APA hundreds of dollars to give you some type of package to help you do it.

This blows.

(And how do I get in on this scheme and become one of those evil people that can make the doctors just pay money to hope it'll go away while all I have to do is sign some paper and I get $1000 per foolish doctor!?!?!-----Just kidding)

So some of the faculty where I'm at have put together a very elaborate presentation on what you need to do that they've presented several places. Apparently the ABPN has actually taken some of their graphics. So, yeah, I guess it's not clear if there's a need for these types of presentations.

 

[Wilf]

A medical degree is worthless without a residency.

We can still do an intern year and then pass step 3 and go right into practice, right? Last time I heard that was true.

 

[notdeadyet]

We can still do an intern year and then pass step 3 and go right into practice, right? Last time I heard that was true.

Kind of moot. Even if you're able to do this (and it varies by state), you will have a tough-to-impossible time getting approved for insurance.

So theoretically you could try to do cash practice, but none of these folks would really go to an intern-level provider.

I'd also be curious what malpractice would look like for an intern-level clinician. Thankfully that animal is dying a rapid death.

 

[masterofmonkeys]

Kind of moot. Even if you're able to do this (and it varies by state), you will have a tough-to-impossible time getting approved for insurance.

So theoretically you could try to do cash practice, but none of these folks would really go to an intern-level provider.

I'd also be curious what malpractice would look like for an intern-level clinician. Thankfully that animal is dying a rapid death.

so you're for the elimination of marginally-supervised PAs and NPs I'm guessing?

On another note, is there any accountability for these quasi-governmental agencies? Whether it's the USMLE and their weaksauce Step II CS moneytrap or the ABPNs absurd testing fees, or the money that we crap out for FSMB documentation verification, or the mission creep of well everyone, it's kind of out of control.

 

[Doctor Bagel]

We can still do an intern year and then pass step 3 and go right into practice, right? Last time I heard that was true.

My state board can subject you to additional testing if you're not board certified within x many years of graduation, and the scoop is that maintenance of licensure is going to start to look nearly identical to maintenance of certification, meaning you'll likely eventually have to do this crap to stay licensed.

 

[OldPsychDoc]

On another note, is there any accountability for these quasi-governmental agencies? Whether it's the USMLE and their weaksauce Step II CS moneytrap or the ABPNs absurd testing fees, or the money that we crap out for FSMB documentation verification, or the mission creep of well everyone, it's kind of out of control.

Nope.

(p.s. You left out JHACO...)

 

[Wilf]

Kind of moot. Even if you're able to do this (and it varies by state), you will have a tough-to-impossible time getting approved for insurance.

So theoretically you could try to do cash practice, but none of these folks would really go to an intern-level provider.

I'd also be curious what malpractice would look like for an intern-level clinician. Thankfully that animal is dying a rapid death.

1. Why do you call them intern level if they have completed intern year?
2. I would say that most NPs and PAs are not at the level of a doctor who has completed intern year

 

[billypilgrim37]

I would much rather see someone who at least had the wherewithal to finish their program than someone who didn't. Yes, a pgy2 is probably the equivalent of an experienced NP/pa in many situations, but a new MD/do who didn't go past their intern year is probably a screw-up with poor judgment nowadays.

 

[masterofmonkeys]

I would much rather see someone who at least had the wherewithal to finish their program than someone who didn't. Yes, a pgy2 is probably the equivalent of an experienced NP/pa in many situations, but a new MD/do who didn't go past their intern year is probably a screw-up with poor judgment nowadays.

Ok, I see what you're saying there. It's not so much that PGY1 is inadequate as that someone who doesn't finish has some red flags. That makes more sense.

I think the time spent in training represents an exploitive dynamic (this is not just true of medicine but other disciplines as well such as changing PT to a graduate course of study, the now mandatory postgrad for most PhDs, and some of the changes we've seen in engineering as well) that has a pretty detrimental effect across a wide range of societal areas.

But, specific to medicine, I am getting very wary of the field's direction toward a series of specialists who are not only scared to deal with other systems, but who also demand that no one else can approach 'their turf'. I'm also highly skeptical of 'years in training' as any sort of metric of professional ability. I'm highly skeptical of any bureaucratically ordained metric as indicative of anything for that matter lol.

 

[notdeadyet]

so you're for the elimination of marginally-supervised PAs and NPs I'm guessing?

A PA or NP went through their completion of training. An intern-level drop-out did not.

1. Why do you call them intern level if they have completed intern year?

I use the term intern-level to describe the level of their training: intern. They didn't get beyond it.

2. I would say that most NPs and PAs are not at the level of a doctor who has completed intern year

See above.

 

[F0nzie]

Here's the link to MOC (Maintenance of Certification)

Also,

The ABPN currently has two active MOC programs: The 10-Year MOC Program for Diplomates with time-limited certificates granted before 2012 and the Continuous MOC (C-MOC) Program for Diplomates certified or recertified in 2012 or later. Diplomates who do not maintain their certification according to the requirements of the MOC program in which they are enrolled are no longer certified. A description of the requirements of each program is found in this booklet.

 

[heyjack70]

My state board can subject you to additional testing if you're not board certified within x many years of graduation, and the scoop is that maintenance of licensure is going to start to look nearly identical to maintenance of certification, meaning you'll likely eventually have to do this crap to stay licensed.

WTF? Why is board certification required to be a psychiatrist? Why would your state medical board require it? It should be an extra certification that distinguishes a doctor from the rest of the field, not a requirement to work the job you've been training for for 8+years. There should be a lawsuit against your state board.

This stinks of something pushed through by bureaucrats justifying their existence(as others have mentioned), and academics who are firmly planted in employed positions that no doubt will pay for all of this testing, maintenance, and performance project bull crap.

So what happens if you avoid board certification? Like if you just forego it, what is the risk? If you open a private practice out of residency, there is no requirement to be board certified. What happens in 10 years?

 

[NJWxMan]

If you really think about it, it's just the PIPS that are extra...the CME's are required to maintain state licensure.

 

[heyjack70]

And how much do you have to pay a year on top of the $$$ for the initial exam?

 

[billypilgrim37]

And how much do you have to pay a year on top of the $$$ for the initial exam?

175 right now.

 

[MLT2MT2DO]

Certification and lifelong continued certification is required for pretty much everyone in the medical field.

Why would it be any different for doctors?

 

[michaelrack]

Certification and lifelong continued certification is required for pretty much everyone in the medical field.

Why would it be any different for doctors?

What other medical field is required to take an expensive test at least every 10 years, along with more frequent bs "quality improvement" or ("performance in Practice") projects.

Agree that there are a lot of medical fields that need to do cme along with maintain licensure.

 

[Doctor Bagel]

What other medical field is required to take an expensive test at least every 10 years, along with more frequent bs "quality improvement" or ("performance in Practice") projects.

Agree that there are a lot of medical fields that need to do cme along with maintain licensure.

Yeah, this. My sister is a psychiatric NP, and she doesn't have to do any of this extra crap. I'm turning into one of those angry doctors.

 

[MLT2MT2DO]

What other medical field is required to take an expensive test at least every 10 years, along with more frequent bs "quality improvement" or ("performance in Practice") projects.

Agree that there are a lot of medical fields that need to do cme along with maintain licensure.

Fair enough, not an expensive test every 10 years.

As an MT I had to do x amount of CEs and pay a couple hundreds bucks every 3 years. Governing bodies are going to get their cut, and the majority of CMEs are a joke...it is what it is, I guess I was beaten down at a young age.

 

[sunlioness]

I hear you. We had a staff meeting on "meaningful use" today. It looks like I can look forward to spending so much time checking off ticky boxes and telling patients that they should talk to their primaries about getting that mammogram that I'm not going to have any time at all to address their actual concern. And people wonder why doctors "don't listen".

I also spent some quality time recently doing a learning module on the "cut and paste" function. It was enlightening.

(I don't blame my employer for this at all. This is all federally mandated stuff. And it's not why any of us went into this field)

 

[heyjack70]

anyone interested in starting a separate psychiatric board?

 

[Shikima]

anyone interested in starting a separate psychiatric board?

I fear the fate would be the same as XFL.
😱